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1 Anatomy of the Ocular FundusA review of normal features of the ocular fundus. Fundus photography using various techniques illustrate anatomic features of the ocular fundus. - Figure 1 : A) Color fundus photograph of the left optic disc and peripapillary retina showing a normal optic disc, retinal arteries, retinal veins, and...Devin D. Mackay, MD; Valérie Biousse, MD
2 Anatomy of the Orbits on CT and MRIMRI and CT imaging of the orbit.Valérie Biousse, MD
3 Anatomy of the Trigeminal NerveMRI and CT scan imaging of the trigeminal nerve and its 3 divisions. Figure 1 : trigeminal nerve. Overview Figure 2 : trigeminal nuclei Figure 3 : trigeminal root. Cisternal segment. Figure 3A. FIESTA axial image through midpons. Figure 3B. T2 coronal image through prepontine cistern Figure 4 : trig...Samuel Bidot, MD; Amit M. Saindane, MD; Valérie Biousse, MD
4 Anterior and Posterior ScleritisA case of anterior and posterior scleritis secondary to idiopathic orbital inflammation, also known as orbital pseudotumor. Various imaging modalities are included to demonstrate optic disc edema, macular edema, and fluid in tenon's capsule which may be seen in posterior scleritis. Figure 1 : Exter...Joshua Levinson, MD; Valérie Biousse, MD
5 Aortitis from Giant Cell ArteritisGiant cell arteritis is a life-threatening inflammatory large vessel vasculitis, commonly associated with jaw claudication, temporal headaches, vision changes, and elevated ESR & CRP. This case highlights an additional common presenting feature of GCA at diagnosis - aortitis - and emphasizes the imp...Nithya Shanmugam; Valerie Biousse
6 Artifact from Incomplete Orbital Fat Suppression on Magnetic Resonance ImagingOrbital fat has short relaxation times that results in a hyperintense appearance on T1-weighted magnetic resonance imaging (MRI). Fat suppressed T1 MRI sequences are needed to remove the fat signal and better visualize the orbital anatomy, including the optic nerve. Contrast can be used with fat sup...Matthew Boyko, MD; Valérie Biousse, MD
7 Bilateral Lens Subluxation in Marfan SyndromeThis is a case of known Marfan syndrome with bilateral progressive visual loss. The ocular examination showed bilateral lens dislocation. Figure 1a: Typical superonasal lens subluxation in both eyes Figure 1b: The arrows show the inferior edges of the lenses Figure 2: Optical section of the lenses u...Rabih Hage, MD; Valérie Biousse, MD
8 Bilateral Optic Disc Edema from Hypertensive RetinopathyA 29 year-old woman was assessed for 2 weeks of headaches and 4 days of blurred vision in both eyes. Her blood pressure was 225/135. Her examination showed: best-corrected visual acuity: 20/25 OD, 20/30 OS; pupils equal and reactive without relative afferent pupillary defect; intraocular pressures 1...Benjamin I. Meyer, MD; Valérie Biousse, MD
9 Cavernous Sinus Meningioma Extending into the Orbital ApexSeptic left cavernous sinus and superior ophthalmic vein thrombosis, secondary to left maxillary tooth abscess. MRI characteristics Figure 1 : MRI Orbits (Coronal T2 with fat suppression) : Left periorbital edema (increased T2 signal, yellow arrows) extends inferiorly along the premalar tissues to t...Supharat Jariyakosol, MD; Valérie Biousse, MD
10 Central Retinal Artery Occlusion with Cilioretinal Artery SparingCentral retinal artery occlusion with sparing of the cilioretinal artery Figure 1 : Fundus photographs show retinal whitening in the right eye, with sparing of the perfused retina in the distribution of the cilioretinal artery (arrows); the left eye has a normal funduscopic appearance. Figure 2 : Mo...Supharat Jariyakosol, MD; Valérie Biousse, MD
11 Cerebral Arterial VascularizationArteries of the neck and brain as seen on a CT Angiogram. Figure 1 : Overview. Figure 1A. Anterior view. Figure 1B. Lateral view. Figure 2 : Internal carotid artery. Segmentation. Figure 3 : Internal carotid artery and vertebral arteries. Extracranial part. Posterolateral view. Figure 4 : Internal c...Samuel Bidot, MD; Valérie Biousse, MD
12 Cerebral Venous Sinus Thrombosis with PapilledemaA case of superior sagittal sinus, right transverse sinus and right sigmoid sinus thrombosis, presenting with increased intracranial pressure (headaches, bilateral sixth palsy and papilledema). Figure 1 : Disc photos of the right and left eyes demonstrating bilateral disc edema. Figure 2 : Non-contr...Supharat Jariyakosol, MD; Valérie Biousse, MD
13 Cerebral Venous VascularizationMRV and CTV scan imaging of the brain veins. Figure 1 : Overview. MRV with contrast Figure 1A. Right postero-lateral view. Figure 1B. Sagittal view. Figure 2 : Dural sinuses. Superior endocranial view. CTV. Figure 3 : Dural sinuses. Sagittal endocranial view. CTV. Figure 4 : Dural sinuses. Right an...Samuel Bidot, MD; Amit M. Saindane, MD; Valérie Biousse, MD
14 Checkboard Visual Field Loss Due to Bilateral Homonymous HemianopsiasA 70-year-old man with vascular risk factors was seen for assessment of sudden visual field loss in both eyes. His examination showed: visual acuity: 20/20 OD and 20/25 OS; pupils: equal with no relative afferent pupillary defect; color vision: 14/14 plates correct OU; anterior segment exam: normal ...Rahul A. Sharma, MD, MPH; Valérie Biousse, MD
15 Choroidal Hypoperfusion Defect in Giant Cell ArteritisHere, we present a case of a 62 year-old male with vision loss in the right eye, headaches, and neck/shoulder/temporal pain, found to have choroidal hypoperfusion and diagnosed with giant cell arteritis (GCA). In combination with anterior ischemic optic neuropathy and cotton wool spots, choroidal hy...Nithya Shanmugam; Michael Dattilo; Valerie Biousse
16 Choroidal Infarction in Giant Cell ArteritisAn 80-year-old Caucasian woman presented with a 10-day history of headaches, intermittent binocular diplopia, and jaw pain. Temporal artery biopsy confirmed a diagnosis of giant cell arteritis. Examination showed characteristic large area of choroidal ischemia that is well-known to be associated wit...Wael A. Alsakran, MD; Andre Aung, MD; Valérie Biousse, MD
17 Choroidal Neovascular Membrane in Chronic PapilledemaA 21-year-old woman with papilledema from idiopathic intracranial hypertension developed a peripapillary choroidal neovascular membrane (PCNVM) complicating untreated chronic papilledema 10 years later.George Alencastro; Valerie Biousse
18 Classic Pathology Findings in Giant Cell ArteritisAn 80-year-old Caucasian woman presented with a 10 day history of headaches, intermittent binocular diplopia, and jaw pain. Temporal artery biopsy confirmed a diagnosis of giant cell arteritis. Pathology findings were classic for giant cell arteritis with numerous inflammatory cells in the tunica me...Andre Aung, MD; Corrina Azarcon, MD; Wael A. Alsakran, MD; Valérie Biousse, MD
19 Clinical Features of NeuroretinitisA 13-year-old girl was seen for assessment of blurred vision and optic disc edema in her right eye. Her examination showed: best-corrected visual acuity of hand motion OD and 20/25 OS; pupils: no relative afferent pupil defect; color vision: 0/14 plates OD and 14/14 plates OS; humphrey visual fields...Rahul A. Sharma, MD, MPH; Jason H. Peragallo, MD; Valérie Biousse, MD
20 Coexisting Thyroid Eye Disease and Myasthenia GravisA case of coexisting thyroid orbitopathy and myasthenia gravis. External photographs of the eyes and eyelids, as well as images from an MRI of the orbits, are included. Figure 1 : External photograph of eyes showing right lid retraction and left upper lid ptosis. Figure 2 : External photograph of ...Devin D. Mackay, MD; Valérie Biousse, MD
21 Colloid Cyst HydrocephalusThis is a case of colloid cyst of the third ventricle complicated by severe hydrocephalus, raised intracranial pressure and papilledema. Figure 1: Fundus photographs demonstrating bilateral optic nerve head edema Figure 2a and 2b: T1-weighted axial brain MRI without contrast: Dilation of both later...Rabih Hage, MD; Valérie Biousse, MD
22 Compressive Optic Neuropathy from Cavernous HemangiomaA 42-year-old man was seen for assessment of progressive blurring of vision in his left eye (OS) over several weeks. His examination showed a left optic neuropathy: visual acuity: 20/20 OD and 20/20-2 OS; pupils: 1+ left relative afferent pupillary defect; color vision: 14/14 plates correct OU. Ther...Rahul A. Sharma, MD, MPH; Aaron M. Yeung, MD; Valérie Biousse, MD
23 Cotton Wool Spots in Giant Cell ArteritisThis is a case of cotton wool spots in a patient with temporal artery-biopsy proven temporal arteritis.; ; A 66-year-old woman presents with isolated painless vision loss related to a left optic neuropathy in her left eye. She denies systemic symptoms to suggest giant cell arteritis.; Her examinatio...Rahul A. Sharma, MD, MPH; Valérie Biousse, MD
24 Dilated Episcleral Vessels from Carotid Cavernous Fistula51 year white woman with a 6 months history of chronic right eye redness, periorbital swelling and progressive proptosis. She was seen by multiple providers and treated for dry eye and conjunctivitis. Her examination showed normal visual acuity, color vision and pupils. There was an intraocular pres...Amani Alzayani, MD; Valérie Biousse, MD; Ling Chen Chien, MD
25 Direct Carotid Cavernous FistulaSlideshow describing condition.Emory Eye Center
26 Direct Carotid-Cavernous Sinus FistulaA 40-year-old man presented with decreased vision and redness in his left eye. He had a significant trauma to the left side of his face about one year ago, but did not seek medical attention. External examination showed significant proptosis of the left eye (Figure 1) and conjunctival injection and ...Jonathan A. Micieli, MD; Valérie Biousse, MD
27 Enophthalmos from Breast Cancer Metastasis to the OrbitRight painful ophthalmoplegia with right enophthalmos secondary to breast cancer metastasis to the right orbit.Valérie Biousse, MD
28 Fourth Nerve SchwannomaThis is a case of IVth cranial nerve schwannoma, showing an enhancement in the subarachnoid space consistent with the clinical presentation. Figure 1a : T1-weighted axial brain MRI Figure 1b : T1-weighted axial brain MRI : magnification of the brainstem Figure 1c : T1-weighted axial brain MRI : cr...Rabih Hage, MD; Valérie Biousse, MD
29 Fundus AutofluorescenceThe retinal pigment epithelium (RPE) has many important functions including phagocytosis of the photoreceptor outer segments. The metabolism of the photoreceptor outer segments leads to the formation of lipofuscin. Disease states and potentially increased oxidative damage can lead to the buildup of ...Jonathan A. Micieli, MD; Valérie Biousse, MD
30 Funduscopic Findings of Acute Central Retinal Artery OcclusionA 59-year-old man was referred for assessment acute vision loss in the right eye. His examination showed: best-corrected visual acuity: light perception OD, 20/20 OS; pupils: Relative afferent pupillary defect OD; color vision: unable to visualize control plate OD, 14/14 OS correct Ishihara plates. ...David B. Enfield, MD; Valérie Biousse, MD
31 Ganglion Cell Layer Analysis by Optical Coherence Tomography (OCT)A normal optical coherence tomography (OCT) of the macula is shown (Figure 1) and the various layers of the retina are labelled (Figure 2). The cell bodies of retinal ganglion cells (RGC) are located in the ganglion cell layer (GCL) of the retina and mostly synapse in the lateral geniculate nucleus ...Jonathan A. Micieli, MD; Valérie Biousse, MD
32 Geniculate Nucleus Metastasis with Homonymous SectoranopiaThis is a case of multiple brain metastases in the setting of bladder cancer complicated with right homonymous horizontal sectoranopia. Figure 1: Pet-scan showing liver (yellow arrows) and kidneys (red arrow) metastases Figure 2: Goldmann Visual Fields: Right homonymous horizontal sectoranopia Figu...Rabih Hage, MD; Valérie Biousse, MD
33 Giant Cell Arteritis: Temporal Artery Anatomy and HistologyGross anatomy and histology of the normal superficial temporal artery.; Histopathology of the superficial temporal artery involved by active and healed GCA; Summary of the main histopathologic findings in GCASamuel Bidot, MD; Valérie Biousse, MD
34 Homonymous Hemianopia Secondary to an Intracranial Bleed from an Arteriovenous MalformationThis case demonstrates a homonymous hemianopia resulting from hemorrhage secondary to a ruptured intracranial arteriovenous malformation (AVM), providing grounds for illustration and discussion of the correlations between localization of this lesion on cerebral imaging and resultant visual field and...Lauren Hudson, MD, PhD; Valérie Biousse, MD
35 Incipient Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION)A 61-year old white man with hypertension, diabetes, and dyslipidema was seen in neuro-ophthalmology consultation for asymptomatic right optic disc edema. He had a small, crowded optic disc in the left eye known as a "disc-at-risk" (Figure 1). He had normal visual function including normal 24-2 SITA...Jonathan A. Micieli, MD; Valérie Biousse, MD
36 Incipient Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION) Evolving to Symptomatic NAIONA 54-year old woman with hypertension was seen in neuro-ophthalmology consultation for asymptomatic left optic disc edema. She had a small, crowded optic disc in the right eye known as a "disc-at-risk" (Figure 1). Her visual function including 24-2 SITA-Fast Humphrey visual fields were normal in bot...Jonathan A. Micieli, MD; Valérie Biousse, MD
37 Internal Carotid Artery / Posterior Communicating Artery Aneurysm with Third Nerve Palsy Shown on CT AngiogramInternal Carotid Artery / Posterior Communicating Artery Aneurysm with Third Nerve Palsy Shown on CT Angiogram ; anatomic description of vascular and bony findings on the CTA. - Figure 1 : 51 year-old man complaining of painful binocular diplopia. Orange arrows indicate the direction of gaze. In p...Samuel Bidot, MD; Amit M. Saindane, MD; Valérie Biousse, MD
38 Internuclear OphthalmoplegiaA slideshow describing INO; includes a video clip of saccadic delay.Wael A. Alsakran, MD; Valérie Biousse, MD
39 Internuclear Ophthalmoplegia (INO)A 67-year-old man with a known history of heart failure and atrial fibrillation developed binocular horizontal diplopia in right gaze after cardiac catheterization. His examination showed normal afferent visual function, full ocular movement of the right eye, and slow adducting saccades in the left ...Wael A. Alsakran, MD; Valérie Biousse, MD
40 Interpreting Ocular Fundus Photographs: a brief guideBrief guide for interpreting ocular fundus photographs.Gabriele Berman, MD; Sachin Kedar, MD; Nancy J. Newman, MD; Valérie Biousse, MD
41 Iris TransilluminationSingle case of iris transillumination in a patient with albinism. Figure 1 : Anterior segment photograph demonstrating reddish hue to iris in albinism Figure 2 : Slit lamp photograph with retroillumination demonstrating iris transillumination Figure 3 : Slit lamp photograph with retroillumination...Jason Peragallo, MD; Valérie Biousse, MD
42 Junctional Scotoma from a Sellar MassThis is a case of a 55-year-old woman presenting with gradual painless vision loss in both eyes. Although visual acuity was 20/20 in both eyes, there was a left relative afferent pupillary defect and diffuse pallor of both optic nerves (Figure 1). Visual fields (24-2 SITA-Fast) showed a temporal def...Jonathan A. Micieli, MD; Valérie Biousse, MD
43 Large Frontal Meningioma with Mass Effect and Increased Intracranial PressureThis is a case of frontal meningioma presenting with raised intracranial pressure and bilateral papilledema responsible for visual loss. Figure 1: Goldmann visual field of the left eye. In the right eye, there was no response to the V4e. The visual field is severely constricted in the left eye. Fig...Rabih Hage, MD; Valérie Biousse, MD
44 Large Right Hypophyseal Aneurysm Causing a Junctional ScotomaRight, multi-lobulated superior hypophyseal artery aneurysm measuring 1.6 x 1.2 x 2.2 cm with 6 mm neck causing a right junctional scotoma . Images from a brain CT with contrast, a brain CT angiography with contrast, cerebral angiogram, Humphrey visual fields and ocular fundus photographs are includ...Laurel N. Vuong, MD; Valérie Biousse, MD
45 Large Sellar and Suprasellar Mass (Pituitary Macroadenoma) With Left Third Nerve Palsy and Left Optic Tract CompressionA case of a large sellar and suprasellar pituitary macroadenoma with an associated left third nerve palsy and left optic tract compression. Images from an MRI of the brain with contrast illustrate the imaging characteristics and extent of the tumor. Figure 1 : Humphrey Visual Fields (24-2 SITA-Fast)...Devin D. Mackay, MD; Valérie Biousse, MD
46 Left RAPDVideo clip displaying pupillary examination and RAPD measurement.Valérie Biousse, MD
47 Macular Star in the Setting of NeuroretinitisNeuroretinitis is often inflammatory or infectious in nature. Here, we present a case of Bartonella neuroretinitis and a typical finding of a unilateral "macular star" on color fundus photographs and OCT. The macular star usually appears 1-2 weeks after infection, and is secondary to exudates accumu...Nithya Shanmugam; Valerie Biousse
48 Malignant Hypertension With Bilateral Optic Nerve EdemaThis is a case of malignant hypertension and severe hypertensive retinopathy. A 30-year-old woman with headache and vision loss in the left eye was found to have a markedly elevated blood pressure of 205/100. CT head without contrast showed acute hemorrhage in the right temporal-occipital junction a...Rahul A. Sharma, MD, MPH; Michael Dattilo, MD, PhD; Valérie Biousse, MD
49 Metastatic Ovarian Cancer to the Left Occipital Lobe With Complete Right Homonymous HemianopiaA case of metastatic ovarian cancer to the left occipital lobe with a complete right homonymous hemianopia. Humphrey visual fields as well as images from an MRI of the brain are included. Figure 1 : Humphrey visual fields showing a complete right homonymous hemianopia Figure 2 : MRI brain T1 axial...Devin D. Mackay, MD; Valérie Biousse, MD
50 MRI Characteristics of Cavernous Sinus and Superior Ophthalmic Vein Septic ThrombosisSeptic left cavernous sinus and superior ophthalmic vein thrombosis, secondary to left maxillary tooth abscess. MRI characteristics. Figure 1 : MRI Orbits (Coronal T2 with fat suppression) : Left periorbital edema (increased T2 signal, yellow arrows) extends inferiorly along the premalar tissues to ...Devin D. Mackay, MD; Valérie Biousse, MD
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